Workshop Registration/Release Form

In consideration of the acceptance of this registration I, intending to be legally bound, hereby for my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the Interior Highlands Ancestral Lifeways Association, their representatives, successors and assigns for injuries incurred by me during or because of this event. I also release any and all photos, video or other media documentation to be used for promotional purposes by the hosting entities.

Name 
Address 
City, State Zipcode 
Phone
Email 

 

Signature_______________________________________________________
(Signature of parent or legal guardian if under 18 years of age)

$60/day, $150/weekend

Total: $_____________________________
Mail Check or Money Order to:
IHALA
104 N. Arrowhead Rd.
Willard, MO 65781